Abstract

To the editor: Bruce and Wise (Ann Intern Med 87:574-576, 1977) have reported the occurrence of tuberculosis in four patients after ileal bypass for obesity. In two of their patients, a presumptive diagnosis of tuberculosis was made from liver biopsy showing noncaseating granulomas, with acid-fast organisms identified in one case. We agree that these two patients probably had tuberculosis, but we wish to caution against accepting hepatic granulomas as prima facie evidence for tuberculosis in ileal bypass patients.

We have reviewed liver biopsies from 25 patients who had had ileal bypass surgery. Hepatic granulomas appeared in the biopsies of six